Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field B RI E FI N G SU M MARY 2 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 3 This report is the first of three briefing summaries from a research project exploring digital technologies in Adult Social Care and Social work to support social wellbeing for older community dwelling adults. The research sits within the National Priorities Programme of Adult Social Care and Social Work, a partnership of nine Applied Research Collaborations (ARCs) from across England, funded by the National Institute of Health and Care Research (NIHR) and led by the Kent Surrey and Sussex ARC (ARC KSS). This briefing focuses on findings from 24 qualitative interviews with professionals who work in local authorities in policy at a national and local authority level, and community-based organisations, supporting older adults or as technology developers focusing on social wellbeing and older adult care. Interviews aimed to better understand what technologies are being used by, and developed for, community dwelling older adults at risk of social isolation and included questions about what digital technologies are being adopted, how and why these digital technologies are being used, and how these technologies relate to social wellbeing. Executive Summary From this data we identified six key themes: • Digital technology for social wellbeing • The impact of consumer technology • Artificial Intelligence (AI) and data use through digital technologies: Applications and ethics • Need for a better evidence base • Digital adoption within the complex infrastructure of Adult Social Care • Digital inclusion and exclusion These findings are discussed in the context of digital technologies within Adult Social Care, which has seen an acceleration of adoption and innovation in this field, during and since the COVID-19 pandemic. In England, the pandemic led to a series of lockdowns (2020-2022) when services had to adapt their responses to provide a range of solutions to ensure people had the support they needed without the availability of face-to-face contact. Government and local authorities are committed to further digital innovation, and implementation is seen as vital to ensure a sustainable future of social care. Insights from this research highlight opportunities as well as challenges to this commitment. Recommendations to further these ambitions include: • Tighter industry guidance and regulation concerning the ethical issues such as privacy, ownership and data use of technology use; • More robust evaluation and better sharing of evidence to support digital technology implementation across social care; • Further consideration given to issues of digital inclusion/exclusion to ensure parity of access to goods and services; • The need for more co-production of digital technologies with older adults i.e. working with older adults to find out what would be useful and what would work for them. 4 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 5 Digital Technologies are seen as vital to a sustainable future of social care. Governments and regional authorities are harnessing the power of digital technology to address the needs of their citizens with greater efficiency, speed and relevance. This has been acknowledged in the recent Social Care White Paper (People at the Heart of Care) alongside investment commitments of £150m from national government to target key areas such as: care technology; the development of digital care records; investment in infrastructure and cybersecurity and improving digital skills and confidence across the social care workforce. COVID-19 necessitated an accelerated adoption of digital technologies within 1 Public Involvement is central to the National Priorities Programme. There is a Strategic Lived Experience Group who were consulted on the meaning of social wellbeing. There is also a lived experience Research Advisory Group working with the research team for the digital technologies project. They were also consulted on the meaning of social wellbeing and then co-designed this definition. Background Information Social Wellbeing is quite a nebulous term; more of a subjective feeling. Despite no universal definition in the academic literature common facets include: social participation; inclusion; meaningful occupation and the absence of social isolation and loneliness. For this study we have consulted lived experience groups1 and co-designed the following definition: Definition of Terms health and social care and increased innovation and interest in this domain, but we are now in a period of reflection as to what worked well and for whom. Initial scoping, by our research team, suggests that a primary emphasis in this field leans towards health monitoring (e.g. blood pressure monitoring) and to monitor activity (e.g. home sensors). These consider financial and provider orientated goals but may exacerbate rather than reduce goals of social wellbeing through reduced in-person contact. Technology aimed to alleviating issues related to social wellbeing, particularly for older people living independently in the community has received less research attention. When considering the increasing prevalence of loneliness and social isolation and the known impacts of this on individuals, and on health and social care services, this is a timely research project. ‘Social wellbeing is the ability to live a meaningful life with a sense of belonging and purpose, to feel connected to family, friends and society and not be passed by. The boundaries of this are a personal choice. Social wellbeing sits alongside and is achieved in conjunction with all other types of wellbeing: physical, mental, financial and emotional.’ Digital Technologies are being kept purposely broad during this exploratory stage of the research and is inclusive of commissioned technologies (such as remote monitoring, care management, and assistive technology) as well as ‘consumer technology’ such as smart technology/IOT (Internet of things) and apps available on the general market. 6 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 7 Key Findings Digital technologies to support social wellbeing COVID-19 saw an acceleration of digital technologies and initiated a shift in provision of many services, and adaptations to the ways in which both citizens and professionals are working and living. Technology solutions are being adopted to keep older adults better connected to their families, services and communities through a range of digital technology devices. Participants frequently referred to this as a ‘lifeline’, for professions to maintain some level of communication and service provision as well as a more general lessening of the impact of isolation for older adults that occurred during the COVID-19 lockdowns. However, participants also agreed that more still needs to be done, through evaluations and research, to better understand what works for who, how and under what circumstance. I think we need to shift the conversation and think more about the benefits of technology for prevention and wellbeing… And it’s hard to compare that cost against the cost of a placement in care. P6, Regional Policy Lead In addition to the use of tablets and other devices such as mobile phones to facilitate video calls, participants highlighted a range of creative ways that technology was supporting social wellbeing. Interviews were rich in individual stories where smart devices, apps and assistive technology had the potential to transform lives and support people to live independently in their own homes. However, frustrations were expressed by some participants that the focus of digital technologies are still biased towards offering online services and video conferencing technology. Participants suggest social wellbeing can be a low-cost, high pay-back target for technology. It was felt that a broader focus here would be welcomed and align with the preventative agenda within Adult Social Care. A personalised approach, the right skills and in-depth knowledge of available technology was cited by many participants as key to successful adoption. Here factors that promoted successful adoption include: initial buy in to the need for technology; keeping things simple; building up technology use gradually, focusing on what people already use and support in early stages whilst older adults learnt and realised benefits. Concerns were raised, during interviews, about the perception that all forms of care are set to be automated and both service providers and older adults still value human interaction. It is acknowledged that digital technologies are not a panacea to social care, nor, as addressed in a subsequent theme, a solution that is welcomed, or accessible to everyone. You still need to think about the social interaction very carefully. People still – out of choice - need to see humans, not just digitally. P10, Charity Organisation 8 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 9 Additionally, participants reported that can be a challenge (for both professionals and older adults) to keep up with what digital technologies are on the market with many identifying the need for better sharing of knowledge about the ways that different technologies are being used successfully. There was a consistent call throughout the interviews for more co-production (involving older adults) in the development of these resources and to ensure that new and existing technologies are meeting the needs of the populations the technologies are being designed for. Participants observed that digital technologies are evolving rapidly and becoming increasingly normalised in daily life, which, in turn, is changing engagement with technology for older adults. Professionals reported that many older adults are now less likely to view digital technologies as specialist equipment, or believe they need specialist knowledge to engage with it. We were told that items such as a voice-controlled “personal assistant” (Alexa type devices) are being purchased by older adults to support wellbeing and independence, without the need for social care services referral or assistive technology assessments. Several participants also A number of positives in relation to this mainstreaming of technology into daily life was highlighted by interview participants. Commissioners stated that the digital technology market in Adult Social Care is now a very competitive space and an area in which service users are expecting a choice. This is a significant shift from what one participant called the ‘brown box and pendant’ (digital personal or fall alarms), which was for many years the mainstay of technology to keep older adults safe in their own homes. Additionally, participants noted that this changing landscape is making technology more aesthetically pleasing and desirable, which they believe is reducing stigma of, and negative associations to, traditional telecare. We learnt through the interviews that whilst rapid growth in this field is gradually improving standards, some of the technology designed to monitor people in their own homes, and support wellbeing through increased connection with families, is still in early iterations and not always fit for purpose. The impact of consumer technology stated that often it is family members who are introducing this type of consumer brought technology. Informal family carers are also encouraging older adults to use other digital technologies (such as video doorbells), as well as online services such as internet shopping, to support the role of remote caring and to gain reassurance of the wellbeing and safety of their relatives. In this way digital technologies are supporting the ability of older adults to live independently in their home of choice. Simultaneously digital technologies have the potential to enhance carer wellbeing by improving the ease of giving remote support and offering reassurance. But also, because people expect and want to have technology now, things are changing, it’s reduced stigma and people want choice. They realise that how technology can help them live independently so that is like the key driver, people see the benefits and they want it. P24, Local Authority We’ve been championing assistive technology as well for a very long time, but recognise that there’s an industry barrier, a delivery barrier, and an information barrier to getting that into people’s homes. So, I think we’re starting to see, we’ve seen mainstream tech being adapted by people with disabilities, and older people. In actual fact, some of that is being broken down, because you don’t have to go to a specialist provider to find something that you can adapt for your needs, which is quite exciting. P9, Charity Organisation [Testing] is getting harder now that there’s more people in the digital market coming in who haven’t previously had a social care context. But we will get the device as soon as it’s out and available and we will test it rigorously within the team. Then at the end of that usually it comes into an equipment discussion, to discuss the technology, maybe do some training if we are actually going to adopt it, or decide to kill it and say, ‘We’ve tested it, it’s not reliable, these are the reasons why, even if someone says they’re aware of it we wouldn’t want to provide it.’ That happens less than it used to but there have been technologies, where they don’t do what they’re supposed to do. P4, Local Authority 10 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 11 Much of this development and use of technology to support independent living is in varying stages of development and implementation. Within this shifting dynamic these ethical questions are receiving some consideration at a national and local level within government, local authority and from industry experts and regulators more generally. However, interviews suggested that the primary focus of technologies being introduced via the professional (as opposed to consumer) route is towards more provider orientated goals of efficiency, compliance and audit. Whilst this can give informal carers some reassurance as well as support goals of independent community living, more in depth consideration is required in terms of how people live meaningful and connected lives, and their agency to decline (or use) such technologies. There is the risk of care becoming more transactional, remote and automated, increasing risks of another form of institutionalisation. AI and data use through digital technologies: Applications and ethics Through the interviews there was a sense of excitement regarding the ability of ‘Tech Enabled Care’ to build intelligence. For example, the use of remote monitoring sensors can build real-time data of how an individual is living in their home culminating in a dashboard of information that Adult Social Care can collect. This data can be used to feed into individual assessments and has the potential to shift models away from reactive crisis management to being more proactive with resources, as well as enabling people to live in their own homes. However, participants also highlighted ethical considerations related to this increased data collection through these technologies, and with the wider use of more mainstream technologies to support daily living, such as smart home devices, virtual assistants, sensors, security cameras, smart phones and smart watches. These include: • Concerns of intrusion and privacy which, whilst not always a primary deterrent, raised questions regarding whether there is full transparency and understanding of what information is being collected, stored and used, and issues of consent from those who have limited capacity; Well, what we can do with this new technology is if we deploy it in someone’s home and give them, say, an interim care package, in a month or two’s time we can have a look at what the data is telling us to better inform us what the proper care package or the entire care package needs to be basically. P5, LA Commissioner We’re not Screwfix. We’re not selling lightbulbs. We’re providing care to people who are at high risk. If our IT systems go down for any reason, that in itself is quite risky. If the company that supplies it doesn’t make any effort to get it back up again that quickly, that’s very problematic. P7, Industry Expert • Questions regarding adequate safety nets and about where the ultimate responsibility lies? Here there was a call for better regulation of technology alongside wider comments over the reliability of, and access to, the digital infrastructure on which these technologies run. There were also concerns both in relation to cyber security generally and the possibility of making those already vulnerable more so to scams and hacking; • Additional questions were posed over responsibility for the reliability of the technology, where the ownership of technology sits – with care providers, tech developers or at an individual level; • Concerns about the robustness of data being collected and resourcing to effectively analyse the data received. 12 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 13 So, we are starting focus more on isolation, loneliness and harm of this. Yeah, so that’s dawning on… and it’s starting to be written more and more into agendas and it’s certainly in our digital agenda, both the scope of the council as a whole but also in adult social care’s digital agenda of how we support people. P4, Local Authority Need for a better evidence base Social wellbeing and digital technology are both high on local and national agendas and participants outlined many initiatives and innovations to explore new digital technology solutions to lessen social isolation and loneliness and to facilitate independent living. It was reported that there is funding available for digital technology initiatives within local authorities and within Adult Social Care more broadly, but investment is limited. Interviews highlighted that routes to funding were complex, coming from different sources, and often to support competing priorities. Developers frequently spoke of chasing small pots of funding which was impacting their sustainability and growth. Across the board professionals acknowledged this climate has led to an excess of pilot projects designed to trial different digital technologies in Adult Social Care, without proper evaluation or through to wider implementation. These combined challenges are ultimately creating a gap between the pilots and adoption of technologies at a larger scale. Participants described evaluation difficulties as threefold: • Too often pilot implementations were designed and rolled out in a short time span and with limited expertise or budget dedicated to support a robust evaluation/assessment; • Short-term pilot studies make it difficult to evaluate whether there are longer-term benefits to individuals and cost benefits. Of note, evaluations rarely look specifically at social wellbeing outcomes and participants stated that it was harder to measure the effect of digital interventions that delay the need for care; • Knowledge gained through pilots is not widely mobilised between local authorities or organisations. As a consequence, pilot studies are not creating sufficient empirical data to justify scalable/wider adoption and a proliferation of smaller pilot studies is causing instability throughout the Adult Social Care ecosystem of digital technologies. Technology developers described themselves as ‘constantly teetering on the verge of extinction’ (Industry Expert, P7) which has implications for providers and then older adult users in turn. Another consequence related to an underdeveloped evidence base resultant of these issues, can be an associated impact on policy and funding that would come from a national level to support increased systemic funding for digital technologies to support social isolation. Social wellbeing is high on the agenda, but the evidence around what digital technologies can do to more investment is just not conclusive enough which causes a problem. P8, Government Policy Officer 14 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 15 Digital adoption within the complex infrastructure of Adult Social Care Despite the challenges identified above, participants confirmed that ambitions were high, and the direction of travel is set firmly towards digital adoption in Adult Social Care. However, the social care landscape is complex. Social care services provide support to a wide range of adults including people with learning disabilities, physical disabilities/illnesses and mental illnesses. This support can cover practical activities, personal care and social work input, all intended to help the people receiving social care to live comfortably and to be as independent as possible. Social care is provided through a wide range of care services and in many different forms; it may be funded privately and/or provided formally – through the local authority, the voluntary sector, private funds, or provided informally by family members, friends or neighbours. So, then all the time it’s thinking of how to balance the needs of healthcare, social care and other resource groups that should collaborate, and so on. Otherwise, too many systems are made for one silo, and integrated with everything and great for that silo, but then it becomes a silo-specific tool, which is very different. P21, Tech developer I think sometimes you find it’s the workforce and its own fears of technology that puts that barrier up. So, if you’ve got people that don’t feel confident with technology, they’re very unlikely to suggest it to the person they’re assessing or supporting. And we’re trying to really tackle that whole culture side of it, if you’re giving the support, the knowledge, know what’s out there, then you’re more likely to see that increased referrals coming in, and people more exploring that. I think we’ve always seen tech, up until now, as a bit of an afterthought with practitioners, so it’s almost your physical package of care goes in, and then we might think about tech at the end. We’ve done a real push around, actually, we should be considering tech right at the beginning of that journey and those conversations. So, it’s been an interesting journey so far. P20, Local Authority This complexity has implications for digital technology adoption with Adult Social Care. Across the interviews it became apparent that there are many unique models of working at a national, regional and local level often underpinned by different layers of infrastructure. Participants gave examples of blurred boundaries both in terms of personnel who have a responsibility for technology within organisations and organisational pathways to be able to get support with, or a referral for, technology. Additionally, there are disparities across regions and of funding within and between health, social care and the voluntary and charity sectors. This all means that digital adoption is a complex pathway to navigate. Participants voiced collaboration as an essential criteria to the overall success of digitalisation initiatives and goals. Participants regularly referenced consideration of workforce readiness alongside the scaling up of digital technologies. This was noted as especially pertinent in the context of current pressures and resource within both health and social care but is seen as vital to goals of digital adoption. Understandably there is an element of resistance to this culture change, but communication and digital champions were reported as two primary means to support this shift as new norms are established. 16 Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers Summary of findings from interviews with professionals working in this field – Briefing Summary 17 Digital inclusion and exclusion Research participants reported many ways in which digital technology had increased reach and access of information and services. Common examples included carers who can access information 24/7, people with neurodiversity and better breadth of inclusion for individuals who don’t speak English or belonging to other minority groups. Simultaneously, digital poverty and exclusion persists. Although each participant touched on local innovation (such as technology lending libraries or community champions) to help tackle this growing divide, inequalities, deprivation and infrastructure are all impacting access. More subtle layers of exclusion were also observed, as exemplified below: • Participants stated that for many older adults there was a fear of technology, and it was not something that they identify with. This presents a barrier to anything labelled as technology; [the technology] makes sure we’re reaching a larger pool of people and providing that support in a very timely fashion. P1, Tech Developer The word technology itself worries me because people envisage something with a plug, that’s complicated and think I am not going to touch that. So, it’s breaking down barriers to that. P2, Community Organisation It is imperative that these more subtle barriers of inclusion/exclusion are taken on board to ensure that inequalities are not further exacerbated, potentially closing access to resources for those who perhaps need it most. Social wellbeing is dependent on the ability to access information, people and services, enabling informed choices. Participants recommended that there should always be parallel provision for those who cannot or choose not to use digital technologies. For more information please contact k.almack@herts.ac.uk or a.tingle@herts.ac.uk If citing please use the following: Tingle, A., Almack, K., Toma, M., Prato, L., Waterman, C., Forder, J. (2023) ‘Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers: Summary of findings from interviews with professionals working in this field.’ University of Hertfordshire. • The language of technology that is often taken for granted. Terms like ‘logging on’ ‘mouse’ ‘4G’ were used as examples of language that can be unfamiliar and present an additional hurdle for some older adults who decide to engage with or are recommended digital technologies. However, interviews suggest that misconceptions and ageist assumptions of older adults’ interest and ability also hinder inclusion; • The pace at which services and systems are digitalising is affecting exclusion with associated implications for social wellbeing. Difficulties cited in interviews ranged from older adults accessing cheaper tariffs to knowing what is happening in the local community as most of this is becoming exclusively on-line. Additionally, participants noted that having a phone and Wi-Fi is not necessarily enough for inclusion anymore, with the increasing layers of technology that individuals need to navigate in daily living from accessing the GP to setting up a new television. Funding and Acknowledgments This is an NIHR funded Applied Research Collaboration (ARC) that sits within the National Priorities Programme for Adult Social Care and Social Work led by the University of Kent and the Kent Surrey Sussex ARC. University of Hertfordshire is leading this research topic in collaboration with University of Kent, University of Liverpool, and King’s College London, and ARC East of England. With thanks to the Kent Surrey Sussex, East of England and West Midlands Academic Health Science Networks. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Images courtesy of the Centre for Ageing Better. Design by Croft Design Associates. Tingle, A., Almack, K., Toma, M., Prato, L., Waterman, C., & Forder, J. (2023). Digital Technologies to support social wellbeing of community dwelling older adults in receipt of social care and their carers: Summary of findings from interviews with professionals working in this field. University of Hertfordshire. https://doi.org/10.18745/pb.26539 © 2023 The Author(s). This an open access work distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.